VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 10/01/2021
** VAERS DATABASE Last updated: October 1, 2021**
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Manufacturers

Total Manufacturer
187,133MODERNA
33,878JANSSEN
2,321PFIZER\BIONTECH
1,091GLAXOSMITHKLINE BIOLOGICALS
983UNKNOWN MANUFACTURER
363MERCK & CO. INC.
229SEQIRUS, INC.
45DYNAVAX TECHNOLOGIES CORPORATION
41NOVARTIS VACCINES AND DIAGNOSTICS
29SANOFI PASTEUR
18EMERGENT BIOSOLUTIONS
8PAXVAX
7TEVA PHARMACEUTICALS
4PFIZER\WYETH
3BERNA BIOTECH, LTD.
2SMITHKLINE BEECHAM
2INTERCELL AG
2PROTEIN SCIENCES CORPORATION
1CSL LIMITED

Incidents per State

State Total
77,548
AK1,869
AL5,581
AR3,688
AS47
AZ14,288
CA61,984
CO11,665
CT8,149
DC1,663
DE1,807
FL37,749
FM5
GA15,058
GU120
HI2,453
IA4,625
ID2,692
IL20,334
IN24,007
KS4,615
KY7,696
LA4,887
MA14,654
MD12,514
ME3,129
MH11
MI18,739
MN12,528
MO9,710
MP29
MS2,790
MT2,375
NC16,368
ND1,356
NE2,880
NH3,100
NJ17,634
NM3,916
NV4,239
NY34,355
OH19,081
OK6,195
OR8,636
PA23,083
PR2,370
QM2
RI2,088
SC6,411
SD1,212
TN9,131
TX35,174
UT4,273
VA14,937
VI64
VT1,676
WA14,909
WI11,259
WV2,388
WY861
XB5
XL1
XV2

ID: 1296444
Sex: M
Age: 76
State: MO

Vax Date: 02/27/2021
Onset Date: 03/15/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Crab meat, bee stings

Symptom List: Dysphagia, Epiglottitis

Symptoms: All the classic systems of PMR . Doctors at the Urgent Care diagnosis was PMR and I was called into The Medical Center, and the Doctor also said it was PMR at which time she put me on Prednisone.

Other Meds: Prednisone, 20 mg 3 times per day for 2 days then 2 times per day for 2 days then 1 per day until gone

Current Illness: type 2 Diabetes

ID: 1296445
Sex: F
Age: 33
State: IN

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Oral Steriods, Singulair, Nasal Steriods, Echinecea,

Symptom List: Anxiety, Dyspnoea

Symptoms: Adverse Effects: Throat swelled, heavy wheezing, sneezing, itching from head to toe, ear swollen shut, hives, whole body hypersensitivity and pain, swollen and red arm. Treatment: Albuterol inhaler, Benedryl, Tylenol and ibuprofen until symptoms calmed down. Chose not to seek medical attention at this time unless symptoms continue or get worse.

Other Meds: Benedryl

Current Illness: None

ID: 1296446
Sex: M
Age: 32
State: CO

Vax Date: 04/19/2021
Onset Date: 04/20/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Chest discomfort, Dysphagia, Pain in extremity, Visual impairment

Symptoms: Tinnitus and Hyper acusis

Other Meds: None

Current Illness: None

ID: 1296447
Sex: M
Age: 16
State: VA

Vax Date: 04/16/2021
Onset Date: 04/16/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies: denies

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient experienced a rash around neck and chest within 30 minutes of first vaccine that persisted for several days.

Other Meds: denies

Current Illness: denies

ID: 1296448
Sex: F
Age: 31
State: CA

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: phosphorus in plant fertilizer???

Symptom List: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Feverish, dizziness, started walking into things. Muscle aches and pains all over body. I had to leave work early, I felt so bad the day of the vaccine. I couldn't sleep. I finally fell asleep toward morning and slept until the afternoon. I felt better then. However, by evening, I was freezing cold, even with 2 sweatshirts and blankets, and sweating all night long. I couldn't sleep all night but finally fell asleep toward morning. I woke up at about 11:30. I feel even worse today. I couldn't go to work again today. I am going to drink hot tea and take some Coricidin. Maybe that will help.

Other Meds: Wellbutrin 450 mg, Lamotrigine100 mg, Bystolic 5 mg , Nexplanon

Current Illness: none

ID: 1296449
Sex: M
Age: 47
State: NY

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Chills, Confusional state, Eye inflammation, Headache, Laboratory test

Symptoms: After receiving the Pfizer 2nd dose covid vaccine, the patient sat down in the waiting area chair, as per the 15 minutes post vaccination wait time, and then the patient slid down to the floor. Staff asked the patient if he hit his head, or injured himself in any other way, he said no. He was asked if he blacked out, the patient said "maybe". He was also asked if he needed medical attention, he rejected that as well. He was asked if he had any reactions during his 1st dose and he stated he did not.

Other Meds: N/A

Current Illness: None

ID: 1296450
Sex: M
Age: 45
State: IN

Vax Date: 05/01/2021
Onset Date: 05/05/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Nausea diaherra coughing headaches fatigue muscle arm soreness

Other Meds: None

Current Illness: None

ID: 1296451
Sex: M
Age: 48
State: TX

Vax Date: 05/01/2021
Onset Date: 05/04/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: N/A

Symptom List: Pharyngeal swelling

Symptoms: Woke up with dizziness/vertigo (couldn't walk straight, couldn't think straight, needed to hold onto things to support myself). Symptoms have persisted (but severity has lessened) thru 5/7. I received the second dose on 5/1, and symptoms started the morning of 5/4. I'm still experiencing some dizziness today on 5/7.

Other Meds: N/A

Current Illness: N/A

ID: 1296452
Sex: M
Age: 23
State: TX

Vax Date: 04/29/2021
Onset Date: 05/02/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Around three days after vaccination, I (the patient) suddenly developed significant atopic dermatitis on my arms, legs, and genitals. The location of most severe symptoms was on the knee pits and elbow pits. The skin became red, bumpy, broken, and leaked a significant amount of yellow/clear fluid. The symptoms were not unlike poison ivy but less localized. I (the patient) had not experienced similar symptoms at any point prior and was in good health/not immunocompromised at the time of vaccination. Similar symptoms were not experienced at the time of the first dose being administered. Benadryl and a hydrocortisone cream were used to alleviate symptoms with little success. The symptoms have continued for around a week and have showed signs of improvement.

Other Meds: None

Current Illness: None

ID: 1296453
Sex: M
Age: 46
State: OR

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No known allergies

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient presents with a potential reaction to the COVID19 vaccine. The patient reports a single potential hive on the L forearm, they had the same reaction after the first injection, which responded to Zyrtec. They request repeat dosing. 10mg of oral Zyrtec given for a local skin reaction with good results, as with the previous injection. Returned home at baseline.

Other Meds:

Current Illness:

ID: 1296454
Sex: M
Age: 78
State:

Vax Date: 02/05/2021
Onset Date: 05/02/2021
Rec V Date: 05/07/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: dizzy, weakness, blurry vision, abnormal speech; non-STEMI

Other Meds:

Current Illness:

ID: 1296455
Sex: F
Age: 22
State: MI

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: Patient got warm was sweating fainted temporarily lost eyesight

Other Meds: None

Current Illness: None

ID: 1296456
Sex: F
Age: 40
State: FL

Vax Date: 04/09/2021
Onset Date: 04/16/2021
Rec V Date: 05/07/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No Allergies

Symptom List: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Sharp pain on right leg, difficulty breathing.

Other Meds: Vitamin B12 5000mcg , Slow Release Iron 45mg, Hydrochlorothiazide 12.5 mg, Norethindrone and Ethinyl Estradiol 0.4/0.035 mg

Current Illness: Nothing

ID: 1296457
Sex: F
Age: 37
State: TN

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: no known

Symptom List: Dyspnoea, Fatigue, Feeling abnormal, Head discomfort, Headache

Symptoms: patient reported feeling hot and a fast heartbeat 20 minutes after administration

Other Meds: no known

Current Illness: no known

ID: 1296458
Sex: F
Age: 17
State:

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Pt was administered vaccine prior to being in appropriate age range (>18).

Other Meds:

Current Illness:

ID: 1296459
Sex: M
Age: 71
State: OH

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Wife reported patient "jerked" forward while sitting and almost fell off chair to the left side

Other Meds: low dose aspirin, plavix

Current Illness:

ID: 1296460
Sex: M
Age: 35
State: MA

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

Symptom List: SARS-CoV-2 antibody test, SARS-CoV-2 test negative

Symptoms: Pt had a syncope episode immediately post vaccination. Taken to Hospital

Other Meds:

Current Illness:

ID: 1296461
Sex: F
Age: 55
State: NC

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: HIBV
Manufacturer: MERCK & CO. INC.
Vax Name: HIB (PEDVAXHIB)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: No

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Swelling at injection site immediately after giving vaccination. Place ice on area for 15 minutes. Swelling subsided but since it was still present patient opted to take 600mg of ibuprofen. 15 minutes later swelling went down and a bruise remained. Patient reported no pain or itching at the area. Followed up with patient a few hours later and she stated she did not have any more swelling.

Other Meds: latanoprost, timolol, and dorzolamide eye drops

Current Illness: No

ID: 1296462
Sex: M
Age: 28
State: IL

Vax Date: 04/07/2021
Onset Date: 04/09/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: PNC13
Manufacturer: PFIZER\WYETH
Vax Name: PNEUMO (PREVNAR13)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Shingles starting within 48 hours of vaccination, initially on left side of back, extending to left side of chest. Symptomatic for 10-14 days, scars still there.

Other Meds: None

Current Illness: None

ID: 1296463
Sex: F
Age: 52
State: FL

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: RV1
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: ROTAVIRUS (ROTARIX)
Lot:
Dose Series: 1
Vax Route: PO
Vax Site: MO

Lab Data:

Allergies: Penicillin, sulfa drugs

Symptom List: Blood pressure increased, Chest discomfort, Heart rate increased

Symptoms: 101.4 fever, low grade fever for four days Headache, severe for three days Nausea Vomiting Diarrhea Muscle pain at injection site Swollen lymph nodes under arm (size of large grape) Swollen gums Lethargy, four days

Other Meds:

Current Illness: None

ID: 1296464
Sex: M
Age: 30
State: CA

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No

Symptom List: Injection site erythema, Injection site pruritus, Injection site swelling, Lymph node pain, Lymphadenopathy

Symptoms: Patient received first Moderna dose, was ambulating to obs, fainted. No injuries sustained per patient. Nurse caught him, lowered him to the ground. 1:04pm: BP 88/50 left arm, HR 56. 1:08pm: 126/71 BP left arm, 73 HR. 1:09pm: 123/76 sitting BP LA, 68 HR. 1:14: 124/82 BP LA, 72 HR. Short seizure just before 1:20pm, lasted about 5 seconds. 1:21pm BP LA 126/53, HR 46. 1:24pm BP sitting LA 102/58, HR 55. 1:20pm called 911, EMS arrived on scene, at 1:27pm transported patient.

Other Meds: No

Current Illness: No

ID: 1296465
Sex: F
Age: 75
State: MS

Vax Date: 03/29/2021
Onset Date: 03/30/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Rocephin Vancomycin

Symptom List: Unevaluable event

Symptoms: The next day she began complaining of a headache, nosebleed, fever, and body aches. The symptoms persisted for five days. She has since fully recovered however she did refuse the second dose of the vaccine.

Other Meds: acetaminophen (TYLENOL) 500 MG tablet apixaban (ELIQUIS) 2.5 MG TABS cholecalciferol (VITAMIN D3) 125 MCG (5000 UT) capsule furosemide (LASIX) 20 MG tablet gabapentin (NEURONTIN) 300 MG capsule Heparin Lock Flush (HEPARIN FLUSH, PORCINE,) 1

Current Illness: Short bowel syndrome Infection due to Port-A-Cath CLABSI (central line-associated bloodstream infection) Fever and chills Bacteremia due to Escherichia coli Nausea & vomiting Chronic diarrhea Dehydration Generalized weakness Tobacco use disorder Central line infection Flank pain Back pain Subhepatic fluid collection

ID: 1296466
Sex: M
Age: 53
State: FL

Vax Date: 05/04/2021
Onset Date: 05/07/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: patient came back to pharmacy today as his md advised him to report to us rash on upper left chest, swollen lymph nodes on left under arm, and lower right side stiffness

Other Meds:

Current Illness:

ID: 1296467
Sex: M
Age: 23
State: NY

Vax Date: 03/14/2021
Onset Date: 04/28/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Client received 1 dose Janssen vaccine 3/14/21. Client tested positive for COVID-19 on 4/28/21.

Other Meds:

Current Illness:

ID: 1296468
Sex: M
Age: 63
State: SC

Vax Date: 03/30/2021
Onset Date: 04/07/2021
Rec V Date: 05/07/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: No

Symptom List: Injection site pain, Menorrhagia

Symptoms: One week after vaccination, I had to all 911 and was put in the hospital, I had a stroke, I had a blood clot in my brain, and severe abdominal pain, and terrible headache where the clot was, I couldn't see, my legs weren't working right. My head was sensitive on the right side, like a tingling and sore to touch, then the headache started in the center of my head. I stayed in the hospital for 3 weeks. I'm home but have slurred speech and I use a walker now.

Other Meds: No

Current Illness: No

ID: 1296469
Sex: F
Age: 49
State: NM

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: NKDA

Symptom List: Arthralgia, Chills, Headache, Mobility decreased, Myalgia

Symptoms: Ten minutes after vaccine adminstered to pt. She began to feel nausea. Pt reported feeling light headed and hot and cold flashes. 20 Mintues after pt began feeling better.

Other Meds: Lisinopril 20 MG

Current Illness: none

ID: 1296470
Sex: F
Age: 34
State: FL

Vax Date: 05/01/2021
Onset Date: 05/04/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Allergy to plasil (for vomit)

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: 1. Dizzy 30 mins later 2. As if I was drugged 1 hour later 3. Not speaking coherent 1:40 hour later 4. Walking supported/leaning by a wall 2:00 hours later 5. Could not walk alone and had involuntary movements 6. Dislodged jaw 7. Not standing by my self 9. Winking eyes and not able to open them 10. The left side was weaker than my right side

Other Meds: Calcibon D Calcitrion Rivotril 0.5 mg (am) Lamictal 400 mg Wellbutrin 300 mg Brintellix 30mg Rivotril 0.5 (pm)

Current Illness: Hypothyroidism Depression Hyperparathiroidism Osteoporosis

ID: 1296471
Sex: M
Age: 46
State: SC

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: rash appeared

Other Meds:

Current Illness:

ID: 1296472
Sex: F
Age: 49
State: NM

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: NKDA

Symptom List: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Ten minutes after vaccine adminstered to pt. She began to feel nausea. Pt reported feeling light headed and hot and cold flashes. 20 Mintues after pt began feeling better.

Other Meds: Lisinopril 20 MG

Current Illness: none

ID: 1296473
Sex: F
Age: 57
State: CA

Vax Date: 04/27/2021
Onset Date: 05/05/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Ibuprofen, Ace Inhibitors, shell fish

Symptom List: Nausea

Symptoms: I have gone thru menopause and haven't had a menstrual cycle in about 15 years and have had no female issues ever. On 5/5/21 I had severe cramps and then heavy spotting. It lasted just a few hours. Today on 5/7 I'm having heavy cramping.

Other Meds: Lantus, Humalog, Victoza, Atrovastatin, Telmsartan, Metoprolol, Furosemide, Trazadone, Plavix, Low Dose Aspirin

Current Illness:

ID: 1296474
Sex: M
Age: 55
State: CA

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: N/A

Symptom List: Injection site pain

Symptoms: On Thursday, 5/6/21, client was to receive his first dose of Pfizer COVID vaccine (LOT #: EW0167, exp: 8/2021) at approximately 10:30am. RN administered client's first dose in his left deltoid. Client was observed in the Observation Area for 15 minutes with no adverse effects and left vaccination site with a steady gait at approximately 11:10am. RN finished administering his 6 doses around 11:45am and returned his Participant Form for "Vial 24." RN noticed a duplication in vial number 24 forms. Upon further assessment, RN recognized that she had reconstituted the same Pfizer vial, vial 24, twice with 1.8ml of Normal Saline. Issue was elevated immediately to Clinical Lead who advised to call patient back to receive the proper full dose. Client was called at 1:15pm. RN apologized and explained to client what happened. Client was understanding and verbalized agreement to come back at 2:30pm. Client received his first dose of Pfizer COVID vaccine (LOT #: EW0179, exp: 8/2021) on opposite arm at 2:36pm. Client denied history of severe allergic reactions. Client was observed in Observation Area for 30 minutes. Client was educated by RN on signs and symptoms of adverse reactions and when to go to the ED/call MD. Client was also encouraged to sign-up on v-safe. Client left vaccination site with a steady gait at approximately 3:06pm.

Other Meds: N/A

Current Illness: N/A

ID: 1296475
Sex: M
Age: 70
State: FL

Vax Date: 02/01/2021
Onset Date: 03/23/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: gluten, dairy

Symptom List: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: ABOUT 2 WEEKS AFTER VACCINATION, Patient started with GI symptoms-constipation, diarrhea. The lower GI bleeding started. He was hospitalized twice-sepsis and GI bleeding requiring transfusion and Remicade. Patient had had a colonoscopy in May of 2020 and he was fine-no problems. Not sure if any of this was related but it won't be known until we investigate. No one can say why he was so acute

Other Meds: Losartan, baby ASA, Ropinerole, Metotoprolol, Celexa

Current Illness: parkinsons, history of CVA

ID: 1296476
Sex: M
Age: 46
State: CA

Vax Date: 05/04/2021
Onset Date: 05/05/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: none

Symptom List: Chills, Dizziness, Nausea, Pain, Tachycardia

Symptoms: SO I took the second dose on Tue around noon. Wed around noon I started feeling slight chills and slight body ache. Slept it off until 7 pm . Thu around noon - more body ache about similar chills. Rest for a couple hours, slept it off for a couple of hours. Fri again around noon - similar body ache but significant uncontrollable chills. Body felt warm on and off through these periods noon to 7 pm. Treated with Tylenol (300) + advil (600). Some comfort, but that comfort seems to be lessening over the period. For example the uncontrollable chills today started concerning me. Tylenol took more than an hour to slightly lessen the chills. Had advil to see if that helps. As I write this chills seems to have subsided. But that feeling of warmth especially in the face has returned. Feel like placing a cold towel on the face. Weirdly enough its this noon to 7 pm time frame when the symptoms are at their worst and in any combination really any given day. Outside of that I function pretty well, almost normal! Its past 48 hours so thought I'd report.

Other Meds: none

Current Illness: none

Date Died: 04/28/2021

ID: 1296477
Sex: F
Age: 61
State: MO

Vax Date: 02/01/2021
Onset Date: 04/11/2021
Rec V Date: 05/07/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Info unavailable to reporter.

Symptom List: Tremor

Symptoms: Case had COVID-19 in November 2020 as part of an outbreak in the SNF she lives in. She recovered then received her first COVID-19 vaccination on 1/4/21. She received her 2nd dose of Moderna on 2/1/21. On 4/11/21 she became ill and was transferred to the hospital where she tested PCR positive for COVID-19. She continued to decline and was intubated. She died on 4/28/21 while still in the hospital. The diagnosis on her death summary from the hospital is COVID-19 pneumonia.

Other Meds: Information unavailable to reporter

Current Illness: Info unavailable to reporter.

ID: 1296478
Sex: F
Age: 41
State: OR

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Not on file yet reports a history of anaphylaxis

Symptom List: Erythema, Pruritus

Symptoms: Pt complained of tingling tongue about f15 min after Pfizer vaccine. She has h/o anaphylaxis, but this does not feel the same. Denies SOB, CP, or any other symptoms. Decided to administer 50mg Benadryl p.o. out of an abundance of caution. Pt improved & went home. Knows to call PCP for worsening symptoms

Other Meds:

Current Illness: Not reported

ID: 1296479
Sex: M
Age: 20
State: ME

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies: No Known

Symptom List: Injection site erythema, Injection site induration, Injection site pruritus, Injection site swelling, Myalgia

Symptoms: Patient experienced fainting, describing loss of peripheral vision before experiencing syncope. Patient did not injure himself during the episode as his father was present and nearby; he was able to hold the patient. Symptoms quickly resolved with patient describing quick recovery within a matter of minutes as EMS arrived.

Other Meds: No known

Current Illness: No known

ID: 1296480
Sex: F
Age: 63
State: CA

Vax Date: 03/15/2021
Onset Date: 03/23/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Allergy to Erythromycin; tetracycline; almonds; rabbits; clover

Symptom List: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: The first symptom was the swollen lymph nodes in neck - that lasted a day and a half. About a week ago, same thing - swollen lymph nodes in my neck (or throat area) - that lasted about a day and a half also. Two and 1/2 weeks later, when I developed the swelling and pain in my paratoid gland in my left jaw. Severe swelling - could barely open my mouth. So I saw DR, on the 19th of March. She prescribed a Z-pak antibiotic and the swelling took about a good week to two weeks and maybe a little longer for the swelling and everything to go away. I was on antibiotic for seven days. Since then I have had no other problems.

Other Meds: Vit D; magnesium; Vit C

Current Illness: Basel cell carcinomas - two removed in March 2021

ID: 1296481
Sex: F
Age: 33
State: WA

Vax Date: 04/30/2021
Onset Date: 05/07/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: My arm is itchy and still a large red bump at injection site.

Other Meds: None

Current Illness: None

ID: 1296482
Sex: F
Age: 38
State: NY

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Pt c/o feeling warm, has a hx of syncope after giving blood. Noted to have "passed out" for approximately 3 seconds about 10 minutes after receiving the vaccine. She was observed for 30 minutes and was fine.

Other Meds:

Current Illness:

ID: 1296483
Sex: F
Age: 73
State: OR

Vax Date: 04/02/2021
Onset Date: 04/16/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: PABA, PCN

Symptom List: Chills, Feeling cold, Feeling hot, Myalgia, Pain

Symptoms: Development of painless, asymptomatic Left palmar tendon nodules about 2 weeks following the second Moderna COVID 19 vaccine

Other Meds: Tylenol, codeine, alendronate

Current Illness: n/a

ID: 1296484
Sex: M
Age: 36
State: CA

Vax Date: 04/18/2021
Onset Date: 04/19/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: n/a

Symptom List: Pain in extremity

Symptoms: So day 2-3...fever and chills and extreme fatigue and diziness. Days 7-21 diziness, fatigue upon exertion, higher blood pressure

Other Meds: 15 mg Adderall

Current Illness: n/a

ID: 1296485
Sex: M
Age: 38
State: PA

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: Seasonal

Symptom List: Abdominal pain upper, Abnormal behaviour, Adverse reaction, Anger, Asthma

Symptoms: Pt stated that they were feeling diaphoretic and "tingling" immediately after their first Pfizer vaccination in their left arm. Pt was laid on the ground in a Trendelenburg position and then felt better. After standing patient became dizzy. Last oral intake was at 08:30 hours. Pt was given water and pretzels. Last Vitals conducted 16:25 hrs HR: 97, R: 18, BP: 140/87, SPo2: 98%. Pt was lucid and aware of their surroundings with AxO-4.

Other Meds: Fenofibrate, Omeprazole

Current Illness: Hypercholesterolemia, GERD

ID: 1296487
Sex: F
Age: 48
State: TX

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Pt was administered both Janssen and Moderna vaccines. Janssen occurred on 4/2/21 while Moderna was administered on 4/1/21 and 5/5/21.

Other Meds:

Current Illness:

ID: 1296488
Sex: M
Age: 54
State: CA

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: N/A

Symptom List: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: 10:30 a.m. - 1:00 p.m. (05/04/2021): No symptoms. 1:00 p.m. - 8:30 p.m. (05/04/2021): Shoulder and leg myalgia 8:30 p.m. - 9:30 p.m. (05/04/2021): Chills and fever of 100.2 Midnight (05/05/2021): Fever of 101.1 (took Tylenol Flu Nighttime after taking temperature) 6:30 a.m. (05/05/2021): Headache, fatigue, and fever of 100.9 7:00 a.m. (05/05/2021): Took Tylenol Flu Daytime 1:37 p.m. (05/05/2021): Took ibuprofen for continuing myalgia and headache 4:02 p.m. (05/05/2021): Fatigue, mild myalgia, body temperature 97.9 05/06/2021: Mild fatigue and arm pain; 05/07/2021: Very mild arm pain

Other Meds: N/A

Current Illness: N/A

ID: 1296489
Sex: F
Age: 57
State: IL

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: 4/30 - 2nd shot administered - Symptoms of fatigue, myalgia, injection site pain, and nausea started in 30 mins 5/4 - Patient felt much better 5/5 night - Symptoms started back up again. 5/6 - Pharmacy referred patient to consult PCP

Other Meds:

Current Illness:

ID: 1296490
Sex: M
Age: 16
State: OH

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: No reaction but patient is under the recommended age.

Other Meds: None

Current Illness: None

ID: 1296491
Sex: F
Age: 51
State:

Vax Date: 04/15/2021
Onset Date: 05/06/2021
Rec V Date: 05/07/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: NA

Symptom List: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: Bleeding from arm in spots of bug bites, BRBPR, and unprovoked nose ~1 week after shot, plt count 6k in ER

Other Meds: Dexilant, cymbalta, famvir, synthroid, opsumit, adcirca

Current Illness: Scleroderma

ID: 1296492
Sex: M
Age: 72
State: IN

Vax Date: 05/03/2021
Onset Date: 05/04/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKDA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Pt c/o 24 hour course of HA, fever, chills, joint pain and upset stomach--resolved overnight.

Other Meds: gabapentin 300mg qhs, lisinopril 20mg qdaily and atorvastatin 40mg qdaily, omega-3 1000mg po bid

Current Illness: None

ID: 1296493
Sex: F
Age: 23
State: CA

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: N/A

Symptom List: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: On Thursday, 5/6/21, client was to receive her first dose of Pfizer COVID vaccine (LOT #: EW0167, exp: 8/2021) at approximately 10:30am. RN administered client's first dose in her left deltoid. Client was observed in the Observation Area for 15 minutes with no adverse effects and left vaccination site with a steady gait at approximately 10:50am. RN finished administering his 6 doses around 11:45am and returned his form." Another RN noticed a duplication in forms. Upon further assessment, another RN recognized that she had reconstituted the same Pfizer vial twice with 1.8ml of Normal Saline. Issue was elevated immediately to Clinical Lead who advised to call client back to receive the proper full dose. Client was called at 1:20pm. RN apologized and explained to client what happened. Client was understanding and verbalized agreement to come back at another time. VAERS completed on 4/7/21.

Other Meds: N/A

Current Illness: N/A

ID: 1296494
Sex: F
Age: 36
State: WA

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 05/07/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: unknown

Symptom List: Hot flush, Myalgia, Nausea, Tension headache

Symptoms: 1445: Shortly after receiving vaccine - member reported hot flashes, tingling in hands and wrist, nausea, and generally not feeling well. 1450: Began monitoring vitals, administered 50mg oral Benadryl. Member's symptoms fluctuated between feeling better and returning. 1510: Member with mouth dryness, appeared anxious. 12L o2 via NRB 1515: ambulance called 1517: tingling feeling both legs and chest tightness. 1537: symptoms began to fluctuate between better and worse. Epi administered at 1537. EMS crew assumed care of the patient. Patient transported via ambulance to Deaconess Hospital. Per patient report, was placed on an Epi drip, later titrated and discharged on oral steroids.

Other Meds: unknown

Current Illness: unknown

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm